Comparative Healing of Extraction Sockets Managed with Chromic Gut Sutures and Gelatin Sponge Packing Versus Natural Healing: A PRISMA‑Aligned Systematic Review

Post‑extraction socket management is a routine yet clinically significant aspect of dental practice. While many extraction sites are allowed to heal by secondary intention, absorbable gelatin sponges such as Gelfoam or Surgifoam combined with chromic gut sutures are frequently used to enhance clot stability and soft‑tissue approximation. This PRISMA‑aligned systematic review synthesizes existing literature comparing healing outcomes of extraction sockets managed with chromic gut sutures and gelatin sponge packing versus natural, unsutured healing. Searches of PubMed/MEDLINE, Scopus, and the Cochrane Library identified randomized controlled trials, split‑mouth studies, and systematic reviews evaluating time for hemostasis, postoperative pain, early soft‑tissue healing, and complication rates. Across studies, adjunctive socket management demonstrated improved early hemostasis, reduced postoperative pain, and enhanced initial mucosal healing, while long‑term outcomes were generally comparable in healthy patients. Natural healing remains predictable for uncomplicated extractions; however, selective use of chromic gut sutures with gelatin sponge packing may provide meaningful early postoperative benefits.

chromic gut sutures; Gelfoam; Surgifoam; extraction socket healing; natural healing; hemostatic agents

1. Mahardawi B, Jiaranuchart S, Rochanavibhata S, Arunjaroensuk S, Mattheos N, Pimkhaokham A. The role of hemostatic agents after tooth extractions: a systematic review and meta‑analysis. Journal of the American Dental Association. 2023;154(8):742–752.e1. [Google Scholar] [Crossref]

2. Al‑Suliman W, Wehbeh I, Al‑Hafyan S. Comparative evaluation of Surgicel and Gelfoam in controlling post‑extraction bleeding in patients on anticoagulant therapy: a clinical study. BMC Oral Health. 2025;25:1393. [Google Scholar] [Crossref]

3. Pesce G, Sartoretto SC, Resende RFB, et al. Comparative efficacy of two hemostatic agents in post‑extraction bleeding control following mandibular third molar surgery: a randomized clinical trial. Journal of Functional Biomaterials. 2025;16(9):305. [Google Scholar] [Crossref]

4. Lozano JF, Esposito MG. Hemostatic sponges in oral surgery: mechanisms and clinical outcomes. International Journal of Oral Surgery. 1984;13(5):406–410. [Google Scholar] [Crossref]

5. Kumar KR, Kumar J, Sarvagna J. Hemostasis and postoperative care in dental wounds. Journal of Clinical and Diagnostic Research. 2016;10(9):ZC37–ZC40. [Google Scholar] [Crossref]

6. Davis B, Smith KD. Oral surgery suturing techniques. StatPearls [Internet]. 2023. [Google Scholar] [Crossref]

7. Faris A, Khalid L, Hashim M, et al. Characteristics of suture materials used in oral surgery: a systematic review. International Dental Journal. 2022;72(3):278–285. [Google Scholar] [Crossref]

8. Golpasand Hagh L, Beiki Ghasemi M, Safikhani E, et al. Comparison of tensile strengths of synthetic and natural absorbable sutures in minor oral surgeries: a randomized clinical trial. Galen Medical Journal. 2024;13(SP1):O10. [Google Scholar] [Crossref]

9. Medtronic. Chromic gut absorbable suture: product information. Medtronic; 2025. [Google Scholar] [Crossref]

10. Rahman KU, Shah GM, Ikram M, et al. Effectiveness of resorbable surgical gelatin sponge following impacted mandibular tooth extraction: a prospective split‑mouth study. JSM Dentistry. 2024;11(1):1139. [Google Scholar] [Crossref]

11. Kaddah M, Alkhouri I, Karkoutly M, et al. Efficacy of topical tranexamic acid‑soaked absorbable Gelfoam in relieving post‑extraction pain in warfarin patients: a randomized, triple‑blinded, split‑mouth clinical trial. BMC Oral Health. 2024;24:905. [Google Scholar] [Crossref]

12. Eeckhout C, Seyssens L, Glibert M, et al. A randomized controlled trial comparing collagen matrix to hemostatic gelatin sponge as socket seal in alveolar ridge preservation. Journal of Clinical Medicine. 2024;13(8):2293. [Google Scholar] [Crossref]

13. Udeabor SE, Igbokwe P, Onwuegbuzie A, et al. Socket healing outcomes with various adjunctive materials compared to natural healing: a clinical review. Bioengineering. 2023;10(10):1145. [Google Scholar] [Crossref]

14. Loescher AR, Heasman PA, Lucas VS. Evaluation of surgical interventions in routine dental extractions. International Journal of Oral and Maxillofacial Surgery. 2019;48(1):77–87. [Google Scholar] [Crossref]

15. Mahardawi B, Jiaranuchart S, Arunjaroensuk S, et al. The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta‑analysis. Scientific Reports. 2023;13:12519. [Google Scholar] [Crossref]

16. Sadeghi SH, Hosseini‑Sadeghi S. Comparative evaluation of hemostatic gel versus gelatin sponge on bleeding and pain after tooth extraction: an in vivo study. Asian Journal of Dental Health Sciences. 2025;5(1):1–6. [Google Scholar] [Crossref]

17. Gotfredsen K, et al. Absorbable collagen sponge after impacted third molar extraction: clinical outcomes. Clinical Oral Investigations. 2020;24:1301–1309. [Google Scholar] [Crossref]

• Rationale for Removal of Dental Amalgam Restoration in a Patient with Systemic Lupus Erythematosus: A Case Based Perspective